Hepatitis E: Canada welcomes the world: part2

The clinical and epidemiological features of hev have recently been reviewed. Estimates suggest that up to 2 million cases occur yearly in the Indian subcontinent. hev causes large epidemics of acute self- limited icteric hepatitis often linked to ingestion of contaminated water. More recent data suggest that hev is also a common cause of sporadic hepatitis in developing countries, especially in children. Sero-prevalence for hev antibodies can approach 25% in children from endemic areas despite less frequent icteric hepatitis.

Person to person transmission is less well characterized but may be responsible for some cases of hev. Icteric hev presents clinically as a typical acute viral hepatitis with prodromal and icteric phases. Patients with icteric hev tend to be older (15 to 40 years of age versus less than 10 years of age), have longer incubation periods (mean 40 days versus 30 days) and higher case fatality rates (0.5 to 4% versus 0.1 to 2.7%) than patients with hepat itis A virus from similar geographic areas. hev is also responsible for many cases of fulminant hepatitis in endemic regions. Pregnant females appear to be particularly susceptible to hev, especially when acquired in the third trimester. Visit the best pharmacy giving you asthma inhalers click here and taking the best care of you.

Fulminant hepatitis (over 30% of hev infections in some studies) and high case fatality rates (up to 20%) occur in this patient population, the basis of which remains unclear. Liver biopsy changes of cho l entasis occur with greater frequency than in hepat itis A (at least 50% of cases) but pathological findings are otherwise typical of acute viral hepatitis. Loss of detectable viral genomes in tissue, serum and stool parallels clinical resolution of hepatitis and return of liver histology to normal. Treatment is purely supportive and chronic hepatitis does not occur.

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